Provider Demographics
NPI:1982460952
Name:VILLAGE WITCH THERAPY PLLC
Entity type:Organization
Organization Name:VILLAGE WITCH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:HORIZON
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-659-7588
Mailing Address - Street 1:4741 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1657
Mailing Address - Country:US
Mailing Address - Phone:206-659-7588
Mailing Address - Fax:888-796-4762
Practice Address - Street 1:4741 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1657
Practice Address - Country:US
Practice Address - Phone:206-659-7588
Practice Address - Fax:888-796-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty